CERTIFICATE OF INDEPENDENCE FOR MEMBERS
APPOINTED ON OR AFTER JANUARY 13, 2006
The undersigned, having been appointed to serve as a member of the St. Lawrence County
Industrial Development Agency (the “Agency”) on or after January 13, 2006, hereby certifies,
pursuant to subdivision 2 of Section 2825 of the Public Authorities Law, as follows:
He or she is not, and in the past two (2) years, has not been, employed by the
Agency, or an affiliate in an executive capacity or been employed by an entity
that received remuneration valued at more than $15,000 for goods and services
provided to the Agency or received any other form of financial assistance valued
at more than $15,000 from the Agency.
He or she is not a relative of an executive officer or employee in an executive
position of the Agency or an affiliate.
He or she is not, and in the past two (2) years, has not been a lobbyist registered
under a state or local law and paid by a client to influence the management
decisions, contract awards, rate determinations or any other similar actions of the
Agency or an affiliate.
IN WITNESS WHEREOF, the undersigned has executed this Certificate as of this
day of
, __________
By:
Witness:
Printed Name of Agency Member
(Printed Name)
Date of Appointment
Signature
Signature
Date
Date